title: Impact of a hyperglycemic crises protocol.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the efficacy and safety of an adult hyperglycemic crises protocol based upon the 2009 American Diabetes Association (ADA) consensus statement.
  
  
  METHODS
  We performed a retrospective review of patients treated before and after protocol implementation at a university teaching hospital. A total of 256 adult patients met the criteria for diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) and were treated with an insulin infusion between February 2011 and February 2012 (nonprotocol n = 143, protocol n = 113). Protocol efficacy was evaluated by assessing time to resolution of DKA or HHS, length of stay (LOS) in the intensive care unit (ICU), and LOS in the hospital. Protocol safety was evaluated by assessing the numbers of patients with hypoglycemic and hypokalemic events.
  
  
  RESULTS
  Patients on the hyperglycemic crises protocol experienced a 9.2 hour (95% confidence interval (CI): 4.70-13.70; P<.001) decrease in time to resolution, with nonprotocol patients (n = 143) resolving in 22.78 hours and protocol patients (n = 113) resolving in 13.58 hours. There was no difference in safety outcomes, including the number of patients with moderate hypoglycemia (blood glucose <70 mg/dL), severe hypoglycemia (blood glucose <50 mg/dL), or hypokalemia (K+ <3.3 mmol/L).
  
  
  CONCLUSIONS
  Implementation of a hyperglycemic crises protocol decreased times to resolution of DKA and HHS without increasing the rate of hypoglycemia or hypokalemia.
authors.affiliation: Department of Pharmacy, Methodist University Hospital, Memphis, TN Department of Pharmacy, University Medical Center of Southern Nevada, Las Vegas, Nevada.
authors.forename: Jayme S
authors.initials: JS
authors.lastname: Hara
authors.forename: Aryan J
authors.initials: AJ
authors.lastname: Rahbar
authors.forename: Meghan N
authors.initials: MN
authors.lastname: Jeffres
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Izuora
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002985:Clinical Protocols; D015897:Comorbidity; D016001:Confidence Intervals; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy; D003926:Diabetic Coma / Q000150:complications; D016883:Diabetic Ketoacidosis / Q000188:drug therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006785:Hospitals, University; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007008:Hypokalemia / Q000150:complications / Q000188:drug therapy; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008136:Longevity; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin